A recent ruling on patient suicides by the Florida Supreme Court puts physicians at added risk for something they have little control over.
The Florida Supreme Court's decision to make a physician liable for the suicide of an outpatient who had stopped using her prescribed medication for depression exposes physicians to added risk, even if they aren't residents. Here are a few reasons why this decision is misguided and why it is a risk for all physicians, not just those in Florida.
The day before the patient died she called her physician's office because she had not been feeling well for a few months and had a variety of symptoms, some of which were consistent with depression. This was something her family medicine physician, Joseph Chirillo Jr., had been treating her for, using medication that she advised his office she had stopped taking during the call. Chirillo Jr.'s office advised her she could come to the office to pick up a different anti-depressant and made an appointment for her with a gastroenterologist to investigate other symptoms she was experiencing.
Chirillo is not a psychiatrist or a psychologist. He is a medical doctor specializing in family medicine. Forty percent of primary-care physicians provide mental health care to patients, according to a 2013 article in the Journal of the American Board of Family Medicine. Without their treatment the unmet mental healthcare needs would be even greater.
Mental health care does not receive the attention or resources needed to provide needed care to Americans. There are 3,000 counties in the United States that have inadequate mental health care resources. Estimates indicate only about one-third of Americans with mental health problems actually receive treatment for their condition, according to Personality and Social Psychology Review.
One reason mental healthcare is so poor is linked back to a hypothesis about the purpose and use of emotions that remains widely accepted despite being overturned in 2007. Few people are aware of the new, healthy method of interacting with their emotions. Can a physician be held responsible for a patient's lack of knowledge of the healthy way to use her emotions to develop resilience and healthy mental states and thought patterns? I don't think he can or should; especially when it is highly unlikely the doctor knows the new definition himself.
In this Florida case, the patient stopped taking her anti-depressants and did not inform her doctor for a number of months. How can a physician be held liable for a patient who disregards his instructions and subsequently takes her own life?
Suicide is the second leading cause of death for age ranges 10 – 35 and the fourth leading cause of death for ages 35 – 54.
A primary-care physician who understands the potential to be held liable for a patient's suicide if he/she treats the patient for depression might make it a policy to refer all potential mental health issues to psychiatrists or psychologists. On the surface this policy sounds reasonable but that only works in an ideal world. Two-thirds of primary care physicians report that “they could not get outpatient mental health services for patients,” according to research in Health Affairs.
Moreover, nearly half of the referrals for mental health care are not acted upon. Some practices have turned to co-location which increases patient follow-through from 44 percent to 53 percent, according to a case study published in the Journal of the American Board of Family Medicine earlier this year. And a review in Psychotherapy reports that of those who do follow-through, 47% percent end therapy prematurely.”
Stigma remains a barrier to care and receiving care from the primary-care provider lessens resistance due to stigma.
Why will this increase risk for physicians outside Florida?
The court's decision in this case will allow grieving parents, widows, and widowers the ability to recover financially from attending physicians after their loved one commits suicide. There is also the risk that patients who attempt suicide and incur high medical bills as a result will sue to cover their expenses.
Losing a patient is difficult even when there was nothing the doctor could have done differently. A lawsuit creates significant added stress and it isn’t just losing the lawsuit that creates a nightmare for the physician. The time spent dealing with the lawsuit puts added pressure on the physician. Media coverage may further degrade a doctor's practice and reputation.
We already have a problem with physician burnout, which is significantly impacted by stress. The potential that a doctor will be held responsible for something they have no control over will add to the stress burden and increase burnout. It will also contribute to dissuading our youth from becoming physicians.
While referring patients to psychiatrists or psychologists for mental health services might remove the primary-care physician from potential liability, it is not the best solution for healthcare consumers.
Jeanine Joy, Ph.D. , is founder and CEO of Happiness 1st Institute, a Thrive More Now Company focused on research, education, and training in the root cause of physical, mental, and behavioral health using multi-disciplinary research findings. She wrote True Prevention-Optimum Health, Prevent Suicide: The Smart Way, and Empowered Employees become Engaged Employees. E-mail her here.